...Case Study 1 Heart Failure M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge. 1. What error in teaching most likely occurred when M.G. was discharged 10 days ago? If M.G. is currently following her fluid and salt restriction strictly but is still exhibiting the symptoms of fluid overload in heart failure, there was most likely an error in regards to medication teaching. She would have been prescribed a diuretic to eliminate the fluid that what giving her shortness of breath, edema and weight gain but if not taken correctly or at all this would explain why M.G. is still having these manifestations. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. * Chart View Nursing Assessment: Medications Taken at Home Enalapril (Vasotec) 5 mg po bid Pioglitazone (Actos) 45 mg po every morning Furosemide (Lasix) 40mg/day po Potassium Chloride 20meq/day po 2. Which of these medications may have contributed to M.G.’s heart failure? Explain. ...
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...A 32 year old female present to Emergency Department with severe chest pain, palpitation and vomiting for 3 days. She has been diagnosed with the previous episodes of heart failure and traditional risk factors of CAD in medical history. She described her chest pain with tightedness and flank dull pain at both the areas of kidneys with back pain. On physical examination, Cardiac sounds were normal on auscultation with no tenderness on palpation, no intra-abdominal rebound masses, no neck stiffness, no jugular vein enlargement, no dysmenorrhea, no clubbing, no family history of CAD and no hypertension. She was profound sweating on presence with weight loss, urine retention, fatigability and restlessness from 1 week. Her medications at the time...
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...both venous and arterial beds. Nitroglycerine may be added as a venovasodilator. Contractility can be increased with dobutamine, dopamine or amrinone. Dopamine may increase afterload, whereas dobutamine and amrinone will increase contractility and may also cause vasodilation. 2. If medications are ineffective in managing preload and afterload, what mechanical device might be used and how would it improve cardiac output?: 2. Professors Response: If these measures are not effective, an intra-aortic balloon pump will decrease left ventricle workload by decreasing afterload and increase coronary artery blood flow. 3. Mr.G. improves and is discharged from the hospital; however, he returns to the hospital ED within 10 days with a diagnosis of heart failure. He states that I can t catch my breath and my legs are as big as tree trunks and I have pain on my right side . On assessment you find that he is strictly following the fluid and salt restriction ordered since recent hospital admission but still reports that he has been gaining 1 to 2 pounds every day since discharge. He states that he takes the following medications: Enalapril (Vasotec) 5 mg bid, digoxin 0.125mg qd, furosemide 40 mg qd; potassium chloride 20 mEq qd. The admitting physician orders all the medications but changes the furosemide to 40 mg intravenous push (IVP) qd and 80 mg IVP now. What...
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...Cardiac Case Study Pharmacology 291 Larry Goldie, a 63-year-old Caucasian male, visits the healthcare clinic complaining of increasing fatigue and difficulty breathing. Physical assessment findings include a rapid, irregular heart rate of 138 beats per minute, BP of 140/86, and a respiratory rate of 28. His breath sounds are clear with fine crackles in the bases bilaterally. He has positive jugular vein distention (JDV) bilaterally and 1+ pitting edema of his ankles bilaterally. His initial medical diagnosis is heart failure (HF). His past medical history includes: CHD, MI, and HTN. Larry is admitted to the acute care facility. 1. The nurse considers Larry’s symptoms that differentiate right and left-sided failure. (10 points) Left-...
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...Ellen Diane Windham 11/8/15 Case Study: CHF Helen Montgomery * An 83-year-old female presents to ambulance crew after an episode of sudden weakness. A GP is on scene and has assessed the patient, deciding on hospital admission by ambulance as a matter of urgency. History Patient became very weak and was put to bed by NOK. Her breathing became very laboured and the NOK called for the local GP out-of-hours service to attend. The doctor was on scene within 15 minutes, and upon assessing the patient requested an ambulance transfer to the ED. Initial Clinical Findings * Airway – clear & patent * C Spine – not indicated (MOI/NOI: episode of weakness) * Breathing – tachypnoeic * Circulation – Pulse present, irregular, tachycardic; skin colour normal, cap refill normal * Disability – No LOC before ambulance arrival, patient responding to verbal stimuli Clinical Impression * ? Exacerbation of CHF * ? CVA * ? Post-seizure AMPLE History * A – Allergic to penicillin * M – Currently taking Warfarin, Furosemide * P – History of CVA x 1 year, CHF * L – Last oral intake 7pm the evening previous * E – Son stated patient became very weak before going to bed Observations * Pulse rate 110bpm * Pulse rhythm Irregular * ECG rate 116 * ECG rhythm A Fib * Resp rate 24 per...
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...Definition Heart failure occurs when abnormal cardiac function causes failure of the heart to pump blood at a rate sufficient for metabolic requirements under normal filling pressure. It is characterised clinically by breathlessness, effort intolerance, fluid retention, and poor survival. Fluid retention and the congestion related to this can often be relieved with diuretic therapy. However, diuretic therapy should generally not be used alone and, if required, should be combined with the pharmacological therapies outlined in this review. Heart failure can be caused by systolic or diastolic dysfunction, and is associated with neurohormonal changes. [1] Left ventricular systolic dysfunction (LVSD) is defined as a left ventricular ejection fraction (LVEF) below 0.40. It may be symptomatic or asymptomatic. Defining and diagnosing diastolic heart failure can be difficult. Recently proposed criteria include: (1) clinical evidence of heart failure; (2) normal or mildly abnormal left ventricular systolic function; (3) evidence of abnormal left ventricular relaxation, filling, diastolic distensibility, or diastolic stiffness; and (4) evidence of elevated N-terminal-probrain natriuretic peptide. [2] However, assessment of some of these criteria is not standardised Top of Form Search the BMJ[pic][pic] Bottom of Form • BMJ • BMJ Journals • BMJ Careers • BMJ Learning • Evidence Centre • BMJ Group [pic] [pic] [pic] [pic] [pic] [pic] Home | Log in | Athens...
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...readmission or death within 30 days of discharge after a heart failure hospitalization. American Heart Journal, 164(3). 365-372. Retrieved from: http://www.medscape.com/viewarticle/771215_print This article sought to find an appropriate model to predict the risk of unplanned heart failure readmissions. The primary outcome from chart reviews also included death of heart failure patients within 30 days of discharge. The study looked at Centers for Medicaid and Medicare Services (CMS) models and the LACE+ index, to mention two of many that looked at prediction ability. The LACE+ index is a model that looks at length of stay, acuity, the Charlson comorbidity score and age, to predict readmissions. They found that no one model was appropriate in predicting the 30-day readmission rates, although using a combination of the models was an improvement to that predictor. The authors are all physicians, PhDs, or have a Master’s degree- helping to establish credibility. The authors also make a statement as to the funding of the project and that they (the authors) were solely responsible for all data collection, design and submission approval writing for the project, also lending credibility to the study. The references used for this study were appropriate in age, of the 28; 13 were within the last five years. Statistical data was gathered by experts and calculations made through third party experts, lending validity to the study. This article does not use the words ‘Evidence-Based Practice’...
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...Case Studies on Cardiac Function This is the first case study that is required for the class. Please submit a paper (doesn’t have to be long; you could even give me bullet-point answers to the questions listed below) that answers all of the questions posed after Case Study 1. I have included an easy second case study which, if you complete it, will be worth extra credit. Answers to the first Case Study are worth 25 points and responding to Case Study 1 is required work for the course. The extra credit, which is not required, will be worth a total of 10 points. Case 1 A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin. Discussion Questions 1. Which type of heart failure (left or right sided) is usually associated with dyspnea? Left-sided heart failure is usually associated with dyspnea. What other clinical findings are likely to be present with left-sided heart failure? Other clinical findings that are likely to be present with left-sided heart failure include radiographic cardiomegaly, abnormal apical pulse and...
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...explore the applications of stem cells while avoiding the ethical problems associated with embryonic stem cell research (Seki & Fekuda, 2015). One intriguing area in stem cell research is the potential applications for them in the treatment of cardiac diseases. Studies have explored the potential uses for stem cells for the treatment of heart disease (Yamakawa & Ieda, 2015). Additionally, stem cells have been explored for the treatment of heart failure and myocardial infarction (Rasmussen, et al., 2013). Stem cells and how they may be used for the treatment of various cardiac diseases is an exciting topic and has the potential to change future approaches to the treatment. This paper will examine the applications and significance of stem cells in relation to these common cardiac pathologies. Heart disease is one of the leading causes of death in developed countries and currently there are few effective treatment options available (Yamakawa & Ieda, 2015). This it is important to research and make state of the art treatments available to address this issue. The use of stem cells may become an option for treatment of coronary artery disease (CAD). One approach has involved the use of endothelial progenitor cells (EPCs). In one study, EPCs were introduced into areas affected by ischemia and have been able to generate proliferation of new...
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...head: EDUCATION AND CONGESTIV HEART FAILURE How does patient education affect compliance with Congestive Heart Failure? How does patient education affect compliance with Congestive Heart Failure? How does education affect compliance with congestive heart failure? I have chosen this topic because congestive heart failure is a disease process that continues to grow throughout our communities. These patients tend to be readmitted into the hospital frequently due to noncompliance. Problem Identification Education of congestive heart failure is one of society’s largest challenges. The need to focus on compliance of treatment plan, self management, and patient education of this disease process is essential for favorable outcomes. The articles chosen for the information retrieval paper were located on line at the University of Texas at Arlington library in the CINHL database. These articles were written between the years of 2006 and 2009. All three articles were peer reviewed. While searching the data base for articles, information regarding education, compliance, and outcomes was a key focus. The articles were chosen for their content related to the education process of the patient with congestive heart failure and how compliance would affect outcomes. The knowledge of congestive heart failure of the medical professional was also explored. Summary of Articles First article Congestive heart failure is a debilitating and chronic...
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...Preventing Heart Failure Readmissions Henry D. Santos Purdue University Calumet I. Introduction High morbidity, mortality, and healthcare spending have been connected with heart failure management. As per Gheorghiade et al., every year, there are almost a million cases of hospitalization for heart failure, responsible for 6.5 million hospital days, and estimated expenditures of $37.2 billion here in the United States alone (2013). The incident of heart failure readmissions has increased over the last decades, distinctly related to the aging population and surpassed recovery after a myocardial infarction. Based on the Centers for Medicare and Medicaid Services (CMS) 2005 data, heart failure is the most frequent diagnosis among Medicare beneficiaries and the third highest reimbursement for hospitals (AHRQ, 2013). In 2009, CMS started the public reporting of readmission rates after being discharge for heart failure, and, the year after, the Patient Protection and Affordable Act inaugurated financial penalties for healthcare establishments with most rates of readmission within the 30 days after discharge. The elevated concern relating the want to decrease readmissions has been the biggest focused of national researchers and hospitals with the efforts of identifying and predicting which patients with heart failure are likely to be readmitted. Formulated designs and preventive strategies have been established, in order to avoid unnecessary readmissions. Heart failures risk factors...
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...April 1, 2013 Epidemiology Epidemiology is used to help better understand a diseases process, how they work, and how they are transmitted. This helps us to better treat the disease. The process of epidemiology is lengthy but must be followed accurately to ensure correct diagnosis and treatment. Epidemiology is used when a new disease is found and when a disease reappears in high numbers. A common disease in the elderly is congestive heart failure (CHF). The epidemiology process can be used to better understand the disease, what causes it and how to treat it. According to the World Health Organization (WHO), “Epidemiology is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems. Various methods can be used to carry out epidemiological investigations, such as surveillance and descriptive studies that can be used to study distribution and analytical studies are used to study determinants (WHO, 2011). Epidemiology tries to determine what causes disease and what people can do to prevent disease. Epidemiology was first used when scientists tried to discover causes of diseases, such as smallpox and polio (Cornell University, 1993). Epidemiology is no longer limited to transmissible diseases. Epidemiology usually cannot prove a cause of a disease; it can only show certain risk factors that correlate with a higher...
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...Case Study 1 Heart Failure M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge. 1. What error in teaching most likely occurred when M.G. was discharged 10 days ago? The patient most likely failed to adequately apply the fluid and sodium restrction diet properly. Upon discharge teaching, she probably did not have an appropriate understanding of how much soidum to restrict in her diet, as well as what foods may be high in sodium. She also may not have an adequate understanding of what a "fluid" restriction diet entails. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. * Chart View Nursing Assessment: Medications Taken at Home Enalapril (Vasotec) 5 mg po bid Pioglitazone (Actos) 45 mg po every morning Furosemide (Lasix) 40mg/day po Potassium Chloride 20meq/day po 2. Which of these medications may have contributed to M.G.’s heart failure? Explain. a. Pioglitazone: Side effects:Severe weight gain and water retention (edema) are...
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...to help people become independent as rapidly as possible. She saw how nursing could focus on the patient and on developing a good nurse-patient relationship. She believed that the patient-focused nursing was the most beneficial kind of nursing. Henderson emphasized the use of nursing care plan. To develop effective care plan, collection of necessary information is important. She developed the 14 Basic Needs in her Theory (Fitzpatrick & Whall, 2005) as basis of individualized nursing care plan. The emphasis on the patient individual needs comes from Henderson’s link between the patient and nurse. Henderson’s theory fits in the interactive model because it focuses on the relationship between the nurse and the patients. In this case study, the authors will use Henderson’s 14 Basic Needs to develop Mr. C’s care plan. Each of his problems has a link to one of her...
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...Epidemiology by definition is the study of the distribution and patterns of health-events, health- characteristics and their causes or influences in well-defined populations. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based by identifying risk factors for disease and targets for preventive medicine. Epidemiologists are involved in the design of studies, collection and statistical analysis of data, and interpretation and dissemination of results (including peer review and occasional systematic review).Major areas of epidemiological study include outbreak investigation, disease surveillance and biomonitoring, and comparisons of treatment effects such as in clinical trials. Epidemiologists rely on a number of other scientific disciplines such as biology (to better understand disease processes), biostatistics (to make efficient use of the data and draw appropriate conclusions), and exposure assessment and social science disciplines (to better understand proximate and distal risk factors, and their measurement). I would like to discuss elderly patients as my vulnerable population. There is no set age at which a person maybe under the care of a geriatric physician. The physician aims to promote health by preventing disease and disabilities in geriatric adults. A gerontologist specializes in the aging process. Adult medicine differs from the geriatric patient because the focus is on the elderly patient...
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